Research at UCLH set to change how GI bleeding is treated

UCLH teams were crucial to a large, international research study published in The Lancet over the weekend that is set to change guidelines around the treatment of gastrointestinal (GI) bleeding.

The study – which had substantial input from staff in the acute medical unit (AMU), gastroenterology, emergency department (ED) and intensive care unit (ICU) – found that a common drug (called tranexamic acid), given to address GI bleeds is not effective at lowering rates of death from bleeding, and could in fact be worse for patients.

Dr Daniel Marks and Dr Matthew Banks led research efforts at UCLH – which was one of the top recruiters to the trial that took place at 164 hospitals in 15 countries. The study resolves a key question in the management of GI bleeds – as guidelines had been ambiguous about the benefits of the drug – and it means alternative approaches can be investigated. 

Tranexamic acid (TXA) is known to reduce surgical bleeding and reduce deaths in trauma patients, and there was evidence from small trials that it might also reduce deaths from GI bleeds.

However researchers on the HALT-IT trial found that the drug made no difference to the rate of deaths from GI bleeds. In addition, some events such as deep vein thrombosis and pulmonary embolism (the blockage of an artery in the lungs) were experienced at higher rates by those given TXA.

Dr Marks and Dr Banks said: “The HALT-IT trial is the largest ever clinical trial in gastrointestinal bleeding, and included over 12,000 patients. These results will have a substantial influence on international guidelines, which to date have been equivocal on the use of TXA. Our results are clear – we can rule out the large mortality reduction suggested by previous evidence, which was based on small trials. TXA should not be used routinely for the treatment of GI bleeding outside the context of a randomised trial. The trial paves the way for future research into the best treatment approaches for our patients.

“This research would not have been possible without an exceptional collaboration across teams at UCLH. We want to thank in particular Dr Dave Brealey and his team of research nurses in the ICU as well as the nursing staff in the ED and AMU for their tireless work. And we also want to thank Dr Samer Elkhodair for championing the study in the ED.”

Read the full paper in The Lancet.